Abstract WP320: Uncertainty: A Key Influence in the Decision to Admit Patients With Transient Ischemic Attack

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Barbara J Homoya ◽  
Teresa M Damush ◽  
Jason J Sico ◽  
Edward J Miech ◽  
Gregory W Arling ◽  
...  
Keyword(s):  
Decision Making ◽  
System Level ◽  
Veterans Administration ◽  
Structured Interviews ◽  
Stroke Event ◽  
Long Distance ◽  
Diagnostic Uncertainty ◽  
Data Coding ◽  
Admission Rates ◽  
Project File

Introduction: Hospitalization of TIA patients has been shown to improve the timeliness and quality of TIA care yet admission rates for patients presenting with TIA vary considerably across centers. Methods: We sought to identify patient and system level factors linked to the decision to admit a patient with TIA. Trained interviewers conducted face-to-face semi-structured interviews with staff involved in TIA care at diverse Veterans Administration (VA) sites. All transcripts were de-identified and imported into a single NVivo10 project file for data coding and analysis. Results: 70 audiotaped interviews of multidisciplinary clinical staff took place at 14 Veterans Administration Medical Centers (VAMCs). We identified emergent themes and patterns in providers’ decision making. Uncertainty was a key theme in factors that staff reported as an influence in providers’ decisions to admit including: lack of guidance at sites without a facility TIA-specific policy, diagnostic uncertainty related to the TIA event (versus stroke or stroke mimic), general lack of confidence in the ability to complete a timely workup, and specific concerns about patients living a long distance from a VAMC or lacking a support system. Overall, the ABCD 2 score was reported by participants not as a rationale for decisions to admit, but rather for decisions not to admit. Other reported factors related to the decision not to admit included: longer period of time since symptom onset, lack of symptoms, confidence in the ability to get a timely workup as an outpatient, recent evaluation for a prior TIA or stroke event, close proximity of the patient’s residence to a VA facility, strong patient support at home, currently maximized medical management, and availability of observation beds. Conclusions: Issues related to uncertainty were reported as key factors in clinical decisions concerning admittance of patients presenting with TIA. Quality improvement interventions for TIA care may need to take into consideration how factors like uncertainty relate to the TIA admission decision-making process.

scholarly journals The Impact of Social Media Use on Consumers’ Restaurant Consumption Experiences: A Qualitative Study

2021 ◽  
Vol 13 (12) ◽  
pp. 6581
Author(s):  
Jooyoung Hwang ◽  
Anita Eves ◽  
Jason L. Stienmetz
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Selection Process ◽  
Decision Making Process ◽  
Structured Interviews ◽  
High Standards ◽  
Tourism And Hospitality Industry ◽  
Tourism And Hospitality ◽  
Search For Information ◽  
The Impact

Travellers have high standards and regard restaurants as important travel attributes. In the tourism and hospitality industry, the use of developed tools (e.g., smartphones and location-based tablets) has been popularised as a way for travellers to easily search for information and to book venues. Qualitative research using semi-structured interviews based on the face-to-face approach was adopted for this study to examine how consumers’ restaurant selection processes are performed with the utilisation of social media on smartphones. Then, thematic analysis was adopted. The findings of this research show that the adoption of social media on smartphones is positively related with consumers’ gratification. More specifically, when consumers regard that process, content and social gratification are satisfied, their intention to adopt social media is fulfilled. It is suggested by this study that consumers’ restaurant decision-making process needs to be understood, as each stage of the decision-making process is not independent; all the stages of the restaurant selection process are organically connected and influence one another.

scholarly journals Exploring the Impact of Technology-Facilitated Abuse and Its Relationship with Domestic Violence: A Qualitative Study on Experts’ Perceptions

2021 ◽  
Vol 8 ◽  
pp. 233339362110281
Author(s):  
Renee Fiolet ◽  
Cynthia Brown ◽  
Molly Wellington ◽  
Karen Bentley ◽  
Kelsey Hegarty
Keyword(s):  
Domestic Violence ◽  
Service Providers ◽  
Structured Interviews ◽  
Specialist Service ◽  
Data Coding ◽  
Integral Role ◽  
Impact Of Technology ◽  
The Impact ◽  
The Relationship ◽  
Inductive Thematic Analysis

Technology-facilitated abuse can be a serious form of domestic violence. Little is known about the relationship between technology-facilitated abuse and other types of domestic violence, or the impact technology-facilitated abuse has on survivors. The aim of this interpretative descriptive study is to understand domestic violence specialist service providers’ perspectives on the impact of technology-facilitated abuse, and the link between technology-facilitated abuse and other forms of domestic violence. A qualitative approach using 15 semi-structured interviews were undertaken with Australian domestic violence specialist practitioners, and three themes were identified through data coding using inductive thematic analysis. Another form of control describes technology-facilitated abuse behaviors as enacting controlling behaviors using new mediums. Amplifies level of fear characterizes the impact of technology-facilitated abuse. A powerful tool to engage others describes opportunities technology offers perpetrators to abuse through engaging others. Findings highlight technology-facilitated abuse’s complexity and integral role in domestic violence and can assist clinicians to understand the impact and harm that can result from technology-facilitated abuse.

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

Purchasing Power and Self-Determination: Social Worker Perspectives

2021 ◽  
Author(s):  
Charlotte Bailey ◽  
Debbie Plath ◽  
Alankaar Sharma
Keyword(s):  
Decision Making ◽  
Social Work ◽  
Social Workers ◽  
Work Practice ◽  
Social Work Practice ◽  
Self Determination ◽  
Purchasing Power ◽  
Service Users ◽  
Structured Interviews ◽  
Management Approaches

Abstract The international policy trend towards personalised budgets, which is designed to offer people with disabilities purchasing power to choose services that suit them, is exemplified in the Australian National Disability Insurance Scheme (NDIS). This article examines how the ‘purchasing power’ afforded to service users through individualised budgets impacts on social work practice and the choice and self-determination of NDIS service users. Social workers’ views were sought on the alignment between the NDIS principles of choice and control and social work principles of participation and self-determination and how their social work practice has changed in order to facilitate client access to supports through NDIS budgets and meaningful participation in decision-making. A survey was completed by forty-five social workers, and in-depth semi-structured interviews were conducted with five of these participants. The findings identify how social workers have responded to the shortfalls of the NDIS by the following: interpreting information for clients; assisting service users to navigate complex service provision systems; supporting clients through goal setting, decision-making and implementation of action plans; and adopting case management approaches. The incorporation of social work services into the NDIS service model is proposed in order to facilitate meaningful choice and self-determination associated with purchasing power.

scholarly journals Birds of a Feather Flock Together: Disadvantageous Decision Making in Augmented Restless Legs Syndrome Patients with and without Impulse Control Disorders

2021 ◽  
Vol 11 (3) ◽  
pp. 383
Author(s):  
Beatrice Heim ◽  
Philipp Ellmerer ◽  
Ambra Stefani ◽  
Anna Heidbreder ◽  
Elisabeth Brandauer ◽  
...  
Keyword(s):  
Decision Making ◽  
Restless Legs Syndrome ◽  
Impulse Control ◽  
Compulsive Sexual Behavior ◽  
Structured Interviews ◽  
Restless Legs ◽  
Information Sampling ◽  
Patient Groups ◽  
Post Hoc ◽  
Beads Task

Background: Augmentation (AUG) in patients with restless legs syndrome (RLS) can be associated with impulse control disorder (ICD) symptoms, such as compulsive sexual behavior, gambling disorder or compulsive shopping. In this study, we wanted to assess whether RLS patients with AUG differ in decision making from those patients who have augmentation and in addition ICD symptoms (AUG + ICD) in a post hoc analysis of a patient cohort assessed in a previous study. Methods: In total, 40 RLS patients with augmentation (19 AUG + ICD, 21 AUG without ICDs) were included. RLS diagnosis, severity, and diagnosis of augmentation were made by sleep disorder specialists. ICD symptoms were assessed using semi-structured interviews. All patients performed the beads task, which is an information sampling task where participants must decide from which of the two cups colored beads were drawn. Results were compared to 21 healthy controls (HC). Results: There was no difference in information sampling or irrational decision making between AUG and AUG + ICD patients (p = 0.67 and p = 1.00, respectively). Both patient groups drew less beads and made more irrational decisions than HC (all p-values < 0.03, respectively). Conclusions: Our results suggest that augmentation itself is associated with poorer decision making even in the absence of ICD symptoms. Further studies are necessary to explore whether rapid and hasty decision making are a harbinger of augmentation in RLS.

scholarly journals A new measure of group decision-making efficiency

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Cheng-Ju Hsieh ◽  
Mario Fifić ◽  
Cheng-Ta Yang
Keyword(s):  
Decision Making ◽  
Information Processing ◽  
Group Decision Making ◽  
Group Decision ◽  
Detection Task ◽  
Detection Sensitivity ◽  
System Level ◽  
Workload Capacity ◽  
Individual Decisions ◽  
Collective Benefit

Abstract It has widely been accepted that aggregating group-level decisions is superior to individual decisions. As compared to individuals, groups tend to show a decision advantage in their response accuracy. However, there has been a lack of research exploring whether group decisions are more efficient than individual decisions with a faster information-processing speed. To investigate the relationship between accuracy and response time (RT) in group decision-making, we applied systems’ factorial technology, developed by Townsend and Nozawa (Journal of Mathematical Psychology 39, 321–359, 1995) and regarded as a theory-driven methodology, to study the information-processing properties. More specifically, we measured the workload capacity CAND(t), which only considers the correct responses, and the assessment function of capacity AAND(t), which considers the speed-accuracy trade-off, to make a strong inference about the system-level processing efficiency. A two-interval, forced-choice oddball detection task, where participants had to detect which interval contains an odd target, was conducted in Experiment 1. Then, in Experiment 2, a yes/no Gabor detection task was adopted, where participants had to detect the presence of a Gabor patch. Our results replicated previous findings using the accuracy-based measure: Group detection sensitivity was better than the detection sensitivity of the best individual, especially when the two individuals had similar detection sensitivities. On the other hand, both workload capacity measures, CAND(t) and AAND(t), showed evidence of supercapacity processing, thus suggesting a collective benefit. The ordered relationship between accuracy-based and RT-based collective benefit was limited to the AAND(t) of the correct and fast responses, which may help uncover the processing mechanism behind collective benefits. Our results suggested that AAND(t), which combines both accuracy and RT into inferences, can be regarded as a novel and diagnostic tool for studying the group decision-making process.

Consumer perspectives of vocational rehabilitation and return to work following acquired brain injury

2021 ◽  
pp. 1-21
Author(s):  
Kerrin Watter ◽  
Areti Kennedy ◽  
Vanette McLennan ◽  
Jessica Vogler ◽  
Sarah Jeffery ◽  
...  
Keyword(s):  
Brain Injury ◽  
Return To Work ◽  
Vocational Rehabilitation ◽  
Acquired Brain Injury ◽  
System Level ◽  
Structured Interviews ◽  
Post Injury ◽  
Vocational Rehabilitation Services ◽  
Workplace Supports ◽  
Vocational Goals

Abstract Introduction: Following acquired brain injury, the goal of return to work is common. While return to work is supported through different rehabilitation models and services, access to vocational rehabilitation varies within and between countries, and global rates of employment post-injury remain low. The literature identifies outcomes from vocational programs and experiences with return to work, yet little is known about individuals’ perceptions and experiences regarding rehabilitation to support their vocational goals and experiences in attempting to return to work. Method: This qualitative study investigated the experiences of community-living adults with acquired brain injury (n = 8; mean age 45 years; mean time post-injury of 5.5 years) regarding their vocational rehabilitation and return to work. Focus groups and semi-structured interviews were conducted, with data analyzed via thematic analysis. Results: Participants identified negative and positive experiences with vocational rehabilitation and return to work. Five overarching themes were identified: addressing vocational rehabilitation in rehabilitation; facilitators of recovery and return to work; the importance and experience of working again; acquired brain injury and identity; and services, systems and policies. Participants also identified five key areas for early vocational rehabilitation services: education; service provision; employer liaison; workplace supports; and peer mentors. Study findings inform current and future practice and service delivery, at a clinical, service and system level.

scholarly journals ‘Don’t Put the Cart before the Mule!’ Challenging Assumptions Regarding Health-Related Treatment Practices of Working Equid Owners in Northern India

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1307
Author(s):  
Caroline Nye ◽  
Tamlin Watson ◽  
Laura M. Kubasiewicz ◽  
Zoe Raw ◽  
Faith Burden
Keyword(s):  
Decision Making ◽  
Lived Experience ◽  
Health Management ◽  
Animal Health ◽  
Structured Interviews ◽  
Treatment Practices ◽  
Northern India ◽  
Brick Kilns ◽  
Treatment Measures ◽  
Working Equids

This paper challenges assumptions that the health management of working equids among some of India’s poorest communities is mainly dependent upon income, economic influence, or access to veterinary services. Using a mixed-methods approach, hierarchies of treatment practices are revealed through an examination of the ‘lived experience’ of equid owners in brick kilns and construction sites in northern India. Semi-structured interviews with 37 equid owners and corresponding livelihood surveys, combined with data from two focus groups with professional animal health practitioners and the welfare data of 63 working equids collected using the Equid Assessment, Research, and Scoping (EARS) tool, contributed to the findings of the study. Four principal influencing factors were found to affect the decision-making practices of equid owners. Infrastructural factors, community characteristics and experience, owners’ characteristics and experience, and economic factors all impact the belief structures of equid owners. However, without verifying the validity of the treatment measures being employed, some animals are at risk from hazardous treatment behaviours. By understanding decision-making using the theory of planned behaviour, the findings of this study can provide a crucial contribution to informing future interventions involved in the health management and welfare of working equids.

scholarly journals ‘Every medicine is part poison’: a qualitative inquiry into the perceptions and experiences of choosing contraceptive methods of migrant Chinese women living in Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hankiz Dolan ◽  
Mu Li ◽  
Deborah Bateson ◽  
Rachel Thompson ◽  
Chun Wah Michael Tam ◽  
...  
Keyword(s):  
Decision Making ◽  
Contraceptive Method ◽  
Intrauterine Device ◽  
Qualitative Inquiry ◽  
Medical Advice ◽  
The Body ◽  
Hormonal Contraceptives ◽  
Contraceptive Methods ◽  
Structured Interviews ◽  
Women’S Perceptions

Abstract Background In Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women’s contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way. Methods A qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women’s perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method. Results Four major themes were identified, including: ‘every medicine is part poison: hormonal contraceptives cause harm to the body’; ‘intrauterine device, a device used in the past for married women’; ‘it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences’; and ‘it is not necessary to seek medical advice in choosing contraceptive methods’. Conclusions Our findings suggest that Chinese migrant women’s perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals’ and policy makers’ understanding of Chinese migrant women’s contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women’s decision-making needs.

Has Lean improved organizational decision making?

2016 ◽  
Vol 29 (5) ◽  
pp. 536-549 ◽  
Author(s):  
Pascale Simons ◽  
Jos Benders ◽  
Jochen Bergs ◽  
Wim Marneffe ◽  
Dominique Vandijck
Keyword(s):  
Decision Making ◽  
Design Methodology ◽  
Lean Management ◽  
Structured Interviews ◽  
Organizational Decision Making ◽  
Content Type ◽  
Organizational Contexts ◽  
Sustainable Improvement ◽  
Care Processes ◽  
Practical Implications

Purpose – Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization’s decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization’s decision-making context, making it more amenable for QI initiatives. Design/methodology/approach – In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings – Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications – Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value – Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI’s sustainability.

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